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Article: Management of penetrating aortic ulcer and intramural hematoma in the thoracic aorta.

Warner, David L / Bhamidipati, Castigliano M / Abraham, Cherrie Z

Indian journal of thoracic and cardiovascular surgery

2022 Volume 38, Issue Suppl 1, Page(s) 198–203

Abstract: Acute aortic syndrome is a broad clinical entity that encompasses several pathologies. Aortic dissection is a well-studied disorder, but the other most prominent disorders within the scope of acute aortic syndrome, penetrating aortic ulcer and intramural ...

Abstract	Acute aortic syndrome is a broad clinical entity that encompasses several pathologies. Aortic dissection is a well-studied disorder, but the other most prominent disorders within the scope of acute aortic syndrome, penetrating aortic ulcer and intramural hematoma, are more nebulous in terms of their pathophysiology and treatment strategies. While patient risk factors, presenting symptoms, and medical and surgical management strategies are similar to those of aortic dissection, there are indeed nuanced differences unique to penetrating aortic ulcer and intramural hematoma that surgeons and acute care providers must consider while managing patients with these diagnoses. The aim of this review is to summarize patient demographics, pathophysiology, workup, and treatment strategies that are unique to penetrating aortic ulcer and intramural hematoma.
Language	English
Publishing date	2022-03-09
Publishing country	India
Document type	Journal Article
ZDB-ID	2164386-6
ISSN	0973-7723 ; 0970-9134
ISSN (online)	0973-7723
ISSN	0970-9134
DOI	10.1007/s12055-022-01332-3
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Article: Open repair of a ruptured abdominal aorta with an aortoiliac vein fistula in a 7-month-old infant and review of the literature.

Fuson, Olivia I / Hirai, Kelsi / Halleran, Devin R / Jafri, Mubeen / Muralidaran, Ashok / Azarbal, Amir / Abraham, Cherrie Z / Shalhub, Sherene

Journal of vascular surgery cases and innovative techniques

2024 Volume 10, Issue 2, Page(s) 101441

Abstract: Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant. ...

Abstract	Ruptured abdominal aortic aneurysms are extremely rare in the pediatric population. In this video case report, we describe the successful repair of a ruptured abdominal aortic aneurysm in a 7-month-old female infant.
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2024.101441
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Article: Cerebral embolic protection during endovascular arch replacement.

Herman, Christine R / Rosu, Christian / Abraham, Cherrie Z

Annals of cardiothoracic surgery

2018 Volume 7, Issue 3, Page(s) 397–405

Abstract: Despite excellent results in high volume centers, open repair of aortic arch pathology is highly invasive, and can result in significant morbidity and mortality in high risk patients. Near-total and hybrid approaches to aortic arch disease states have ... ...

Abstract	Despite excellent results in high volume centers, open repair of aortic arch pathology is highly invasive, and can result in significant morbidity and mortality in high risk patients. Near-total and hybrid approaches to aortic arch disease states have emerged as an alternative for patients deemed moderate to high risk for conventional repair. Advantages of these approaches include avoidance of extracorporeal circulation and hypothermic circulatory arrest as well as avoidance of cross clamping, all of which are not well tolerated in high risk patients. Anatomically high-risk patients with anastomotic aneurysms from previous arch reconstruction may also benefit from these less invasive approaches. Medical devices designed specifically for the aortic arch are developing at a rapid pace and continue to evolve. Dedicated devices for zone 0-2 aortic arch repair are currently available under special access or being studied in clinical trials. Unfortunately, stroke continues to be the Achilles heel of endovascular approaches to the aortic arch, with cerebral embolism being the culprit in the majority of such cases. This perspective article describes the epidemiology, procedures, and mitigation strategies for current near-total and hybrid approaches to aortic arch pathology, and specifically addresses current means of embolic protection and future direction.
Language	English
Publishing date	2018-07-30
Publishing country	China
Document type	Journal Article
ZDB-ID	2713627-9
ISSN	2304-1021 ; 2225-319X
ISSN (online)	2304-1021
ISSN	2225-319X
DOI	10.21037/acs.2018.04.09
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Article: Total endograft replacement of aortic arch.

Neequaye, Simon / Abraham, Cherrie Z

Annals of cardiothoracic surgery

2013 Volume 2, Issue 3, Page(s) 362–366

Abstract: Total endovascular replacement of the aortic arch is a complex procedure that is often favoured when the pathology anatomy precludes a standard median sternotomy. Here we present the case of endograft repair in a 79 year old male with 6.5 cm arch ... ...

Abstract	Total endovascular replacement of the aortic arch is a complex procedure that is often favoured when the pathology anatomy precludes a standard median sternotomy. Here we present the case of endograft repair in a 79 year old male with 6.5 cm arch aneurysm and 5.4 cm descending thoracoabdominal aneurysm. Following bilateral carotid-subclavian bypasses, a long 7 Fr sheath was advanced into the descending aorta through the common iliac artery purse string. A double curved long Lunderquist wire was guided to deep within the left ventricle, and the endograft carefully advanced over the wire. The graft was radiologically orientated, and deployed under asystolic conditions. Retrograde cannulation of the branches were accomplished, with carotid sheath placed into the branches followed by bridging stents. The graft delivery system was then removed. This approach obviates the need for a sternotomy, cumbersome extra-anatomic debranching, and hypothermic circulatory arrest.
Language	English
Publishing date	2013-08-14
Publishing country	China
Document type	Journal Article
ZDB-ID	2713627-9
ISSN	2304-1021 ; 2225-319X
ISSN (online)	2304-1021
ISSN	2225-319X
DOI	10.3978/j.issn.2225-319X.2013.02.06
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Article ; Online: Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent-graft: initial experience.

Abraham, Cherrie Z / Lioupis, Christos

publication RETRACTED

The Journal of thoracic and cardiovascular surgery

2013 Volume 145, Issue 3 Suppl, Page(s) S110–7

Abstract: Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms.: Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent- ... ...

Abstract	Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms. Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents. Results: Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. Conclusions: We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.
MeSH term(s)	Aged ; Aged, 80 and over ; Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Aortography/methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Endoleak/etiology ; Endoleak/therapy ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2013-03
Publishing country	United States
Document type	Journal Article ; Retracted Publication
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2012.11.064
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Article ; Online: Predictors of perioperative morbidity and mortality in open abdominal aortic aneurysm repair.

Landry, Gregory J / Liem, Timothy K / Abraham, Cherrie Z / Jung, Enjae / Moneta, Gregory L

American journal of surgery

2019 Volume 217, Issue 5, Page(s) 943–947

Abstract: Introduction: The major advantage of endovascular abdominal aortic aneurysm repair (EVAR) over open repair (OAR) is improved perioperative morbidity and mortality. Long term results of the two modalities are comparable. We sought to quantify factors ... ...

Abstract	Introduction: The major advantage of endovascular abdominal aortic aneurysm repair (EVAR) over open repair (OAR) is improved perioperative morbidity and mortality. Long term results of the two modalities are comparable. We sought to quantify factors predicting perioperative morbidity and mortality in patients undergoing OAR. Methods: Consecutive non-ruptured OAR were analyzed for patient demographic factors, perioperative variables including blood pressure, temperature, and glucose control, intraoperative factors, and complications including wound, pulmonary, renal and cardiac, and 30-day mortality. Uni- and multivariate analysis was performed to determine predictors of morbidity and mortality. Results: 240 elective open AAA repairs over 10 consecutive years were performed. 46% required suprarenal clamping. At least one complication occurred in 47% and 30-day mortality was 5.4%. By multivariate analysis, independent predictors of morbidity (any complication) were suprarenal clamping (OR 1.8, 95% CI 1.1-3.2, p = 0.029), operative time (OR 1.005, 95% CI 1.002-1.008, p = 0.002), and low postoperative temperature (OR 1.6, 95% CI 1.1-2.3, p = 0.025). Multivariate predictors of 30 day mortality included advanced age (OR 1.2, 95% CI 1.1-1.3, p = 0.002) and operative time (OR 1.007, 95% CI 1.001-1.013, p = 0.024). Glucose control did not predict morbidity or mortality. Conclusions: Control of postoperative temperature is a potentially modifiable factor that may reduce morbidity in patients undergoing open AAA repair, thereby minimizing the early advantage of EVAR.
MeSH term(s)	Age Factors ; Aged ; Aortic Aneurysm, Abdominal/mortality ; Aortic Aneurysm, Abdominal/surgery ; Body Temperature ; Endovascular Procedures ; Female ; Humans ; Male ; Multivariate Analysis ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Vascular Surgical Procedures/adverse effects
Language	English
Publishing date	2019-01-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2018.12.054
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Article ; Online: Experienced operators achieve superior patency and wound complication rates with endoscopic great saphenous vein harvest compared with open harvest in lower extremity bypasses.

Kronick, Matthew / Liem, Timothy K / Jung, Enjae / Abraham, Cherrie Z / Moneta, Gregory L / Landry, Gregory J

Journal of vascular surgery

2019 Volume 70, Issue 5, Page(s) 1534–1542

Abstract: Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH) vs open vein harvest (OVH). We hypothesize that the inferior patency ... ...

Abstract	Objective: Prior studies have suggested improved wound complication rates but decreased primary patency in lower extremity bypasses performed with endoscopic vein harvest (EVH) vs open vein harvest (OVH). We hypothesize that the inferior patency reflects the initial learning curve for EVH and that improved patency can be achieved with experience. Methods: This was a single-institution review of 113 patients with critical limb ischemia who underwent infrainguinal bypass with a continuous segment of great saphenous vein harvested endoscopically (n = 49) or through a single open incision (n = 64) from 2012 to 2017. EVH was performed by surgeons with >5 years' experience with this technique. Operative outcomes, patency, complications, and readmission rates were compared between the harvest methods. EVH data were also compared with our prior reported series of our initial experience with this technique to determine the effects of experience on outcomes. Results: There were no significant differences in patient demographics, medications, operative indications, or inflow/outflow vessels between the two groups. Mean operative time was 322 minutes and median hospital length of stay was 6 days for OVH, and was 340 minutes and 5 days for EVH, which was not significant. Harvest-related wound complications were more frequent with OVH (28% vs 2%, P < .001). Primary patency at 1 and 3 years was 65% and 58% for OVH, and 79% and 71% for EVH, respectively (P = .18), assisted primary patency was 77% and 74% for OVH and 94% and 89% for EVH, respectively (P = .05), and secondary patency was 82% and 79% for OVH and 95% and 95% for EVH, respectively (P = .03). The 30-day readmission rates were similar between OVH (20%) and EVH (12%, P = .26), but 90-day readmissions were more frequent in the OVH group (34% vs 14%, P = .018). Compared with our earlier series of EVH, the current cohort had significantly improved 3-year primary (71% vs 42%, P = .012), primary assisted patency (89 vs 66%, P = .034), and secondary patency (95% vs 66%, P = .003). Conclusions: With experience, lower extremity bypass using EVH can result in improved patency compared with OVH and initial EVH use, while also resulting in fewer wound complications and readmissions, with comparable operative times and hospital length of stay. This technique should be more widely adopted by vascular surgeons as a primary method of vein harvest.
MeSH term(s)	Aged ; Aged, 80 and over ; Endoscopy/adverse effects ; Endoscopy/methods ; Female ; Follow-Up Studies ; Humans ; Ischemia/etiology ; Ischemia/surgery ; Length of Stay/statistics & numerical data ; Limb Salvage/adverse effects ; Limb Salvage/methods ; Lower Extremity/blood supply ; Male ; Middle Aged ; Patient Readmission/statistics & numerical data ; Peripheral Arterial Disease/complications ; Peripheral Arterial Disease/surgery ; Saphenous Vein/transplantation ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Tissue and Organ Harvesting/adverse effects ; Tissue and Organ Harvesting/methods ; Transplantation, Autologous/adverse effects ; Transplantation, Autologous/methods ; Treatment Outcome ; Vascular Patency
Language	English
Publishing date	2019-05-29
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	605700-7
ISSN	1097-6809 ; 0741-5214
ISSN (online)	1097-6809
ISSN	0741-5214
DOI	10.1016/j.jvs.2019.02.043
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Article ; Online: Results and challenges for the endovascular repair of aortic arch aneurysms.

Lioupis, Christos / Abraham, Cherrie Z

Perspectives in vascular surgery and endovascular therapy

2011 Volume 23, Issue 3, Page(s) 202–213

Abstract: Endovascular aortic arch reconstruction provides an attractive alternative to treat aortic arch disease in high-risk patients who would otherwise be unsuitable for open repair. Success with multibranched stent grafts in the thoracoabdominal aorta along ... ...

Abstract	Endovascular aortic arch reconstruction provides an attractive alternative to treat aortic arch disease in high-risk patients who would otherwise be unsuitable for open repair. Success with multibranched stent grafts in the thoracoabdominal aorta along with recent advances in design such as the precurved inner nitinol cannula have simplified the endovascular reconstruction of aortic arch aneurysms with multibranched stent grafts. These devices allow for greater flexibility in conforming to difficult anatomy and preserving important side branches. During the first surgical stage, a left carotid -subclavian bypass or left subclavian artery transposition is performed. The second stage is the endovascular procedure. The device is inserted through a transfemoral approach, and crossing of the aortic valve with the device is necessary. The stent graft is deployed during brief periods of rapid pacing. Bridging from the branches to the innominate and left common carotid arteries requires a suitable covered stent. In the case of a large-diameter innominate artery, a custom-made bridging limb has to be used to ensure that adequate length and size are available. Direct flow to the innominate and left common carotid arteries do not cease for any significant time during the procedure. Initial experience with mean follow up more than 6 months is encouraging. The method is not suitable for patients with extensive atheromatous involvement of the aortic arch. Careful preoperative planning (preoperative imaging, device construction, and access issues), high endovascular skills, and appropriate imaging equipment are imperative for a successful result. Long-term follow-up is necessary to evaluate the efficacy and safety of these new devices.
MeSH term(s)	Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Aortography/methods ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Blood Vessel Prosthesis Implantation/instrumentation ; Endovascular Procedures/adverse effects ; Endovascular Procedures/instrumentation ; Humans ; Patient Selection ; Prosthesis Design ; Stents ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2011-09
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2054424-8
ISSN	1521-5768 ; 1531-0035
ISSN (online)	1521-5768
ISSN	1531-0035
DOI	10.1177/1531003511413608
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Article ; Online: A Novel Model of Tobacco Smoke-Mediated Aortic Injury.

Azarbal, Amir F / Repella, Tana / Carlson, Eric / Manalo, Elise C / Palanuk, Braden / Vatankhah, Nasibeh / Zientek, Keith / Keene, Douglas R / Zhang, Wenri / Abraham, Cherrie Z / Moneta, Gregory L / Landry, Gregory J / Alkayed, Nabil J / Sakai, Lynn Y

Vascular and endovascular surgery

2021 Volume 56, Issue 3, Page(s) 244–252

Abstract: Objective: Tobacco smoke exposure is a major risk factor for aortic aneurysm development. However, the initial aortic response to tobacco smoke, preceding aneurysm formation, is not well understood. We sought to create a model to determine the effect of ...

Abstract	Objective: Tobacco smoke exposure is a major risk factor for aortic aneurysm development. However, the initial aortic response to tobacco smoke, preceding aneurysm formation, is not well understood. We sought to create a model to determine the effect of solubilized tobacco smoke (STS) on the thoracic and abdominal aorta of mice as well as on cultured human aortic smooth muscle cells (HASMCs). Methods: Tobacco smoke was solubilized and delivered to mice via implanted osmotic minipumps. Twenty male C57BL/6 mice received STS or vehicle infusion. The descending thoracic, suprarenal abdominal, and infrarenal abdominal segments of the aorta were assessed for elastic lamellar damage, smooth muscle cell phenotype, and infiltration of inflammatory cells. Cultured HASMCs grown in media containing STS were compared to cells grown in standard media in order to verify our in vivo findings. Results: Tobacco smoke solution caused significantly more breaks in the elastic lamellae of the thoracic and abdominal aorta compared to control solution ( Conclusion: Delivery of STS via osmotic minipumps appears to be a promising model for investigating the early aortic response to tobacco smoke exposure. The initial effect of tobacco smoke exposure on the aorta is elastic lamellar damage and downregulation of (α-SMA) expression by VSMCs. Elastic lamellar damage occurs more frequently in the abdominal aorta than the thoracic aorta and does not seem to be mediated by the presence of macrophages or other inflammatory cells.
MeSH term(s)	Animals ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal/chemically induced ; Disease Models, Animal ; Male ; Mice ; Mice, Inbred C57BL ; Muscle, Smooth, Vascular ; Myocytes, Smooth Muscle/metabolism ; Nicotiana ; Tobacco Smoke Pollution/adverse effects ; Treatment Outcome
Chemical Substances	Tobacco Smoke Pollution
Language	English
Publishing date	2021-12-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2076272-0
ISSN	1938-9116 ; 1538-5744
ISSN (online)	1938-9116
ISSN	1538-5744
DOI	10.1177/15385744211063054
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Article ; Online: Risk Factors for Mortality Among Individuals With Peripheral Arterial Disease.

Amrock, Stephen M / Abraham, Cherrie Z / Jung, Enjae / Morris, Pamela B / Shapiro, Michael D

The American journal of cardiology

2017 Volume 120, Issue 5, Page(s) 862–867

Abstract: Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients ... ...

Abstract	Morbidity and mortality from peripheral arterial disease (PAD) continues to increase. Traditional cardiovascular risk factors are implicated in the development of PAD, yet the extent to which those risk factors correlate with mortality in such patients remains insufficiently assessed. Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, Cox proportional hazards models were used to examine the association of cardiovascular risk factors and all-cause and cardiovascular mortality. A total of 647 individuals ≥40 years old with PAD (i.e., ankle-brachial index [ABI] ≤ 0.9) were followed for a median of 7.8 years. There were 336 deaths, of which 98 were attributable to cardiovascular disease. Compared with never smokers, current (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.62 to 3.71) and former (HR 1.62, 95% CI 1.14 to 2.29) smokers with PAD had higher rates of death. Moderate or vigorous physical activity of ≥10 minutes monthly was associated with lower death rates (HR 0.63, 95% CI 0.44 to 0.91). Also associated with increased rates of cardiovascular death were an ABI of <0.5 (HR 2.56, 95% CI 1.28 to 5.15, compared with those with an ABI of 0.7 to 0.9) and diabetes mellitus (HR 2.50, 95% CI 1.33 to 4.73). Neither C-reactive protein nor body mass index was associated with mortality. In conclusion, tobacco use increased the risk of all-cause and cardiovascular death, whereas physical activity was associated with a decreased mortality risk. A low ABI and diabetes were also predictive of cardiovascular death.
MeSH term(s)	Adult ; Aged ; Ankle Brachial Index ; Cause of Death/trends ; Cross-Sectional Studies ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Nutrition Surveys/methods ; Peripheral Arterial Disease/diagnosis ; Peripheral Arterial Disease/mortality ; Predictive Value of Tests ; Prognosis ; Risk Assessment/methods ; Risk Factors ; Survival Rate/trends ; Time Factors ; Ultrasonography, Doppler ; United States/epidemiology
Language	English
Publishing date	2017-09-01
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2017.05.057
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